Health insurance and schools for immigrant families

How health coverage works in the U.S.

The U.S. has no single national health system for working-age adults. Most people are covered through an employer, a family member's plan, the Affordable Care Act (ACA) Marketplace or a public program such as Medicaid. Health care without coverage can be very expensive, so arranging insurance should be one of your first tasks after arriving. Our moving to the U.S. checklist lists the others.

Coverage options by situation

Can immigrants get ACA Marketplace coverage in 2026 and 2027?

To buy a Marketplace plan you must live in the state, not be incarcerated, and be a citizen, national or "lawfully present" immigrant. Subsidies called premium tax credits lower the monthly cost for eligible people. A 2025 federal law (Public Law 119-21) and related rules are changing who can get those subsidies:

• From tax year 2026, lawfully present immigrants with income below 100% of the federal poverty level who are ineligible for Medicaid because of their status no longer qualify for premium tax credits. The law also removed the cap on repaying excess advance subsidies, so overestimated help must be paid back in full.
• From tax year 2027, premium tax credits are limited to citizens and nationals plus three groups of "eligible aliens": lawful permanent residents, Cuban and Haitian entrants, and people living in the U.S. under a Compact of Free Association. Many other lawfully present immigrants, such as refugees and asylees without green cards, people with TPS, and many visa holders, could still buy Marketplace plans but at full price.
• DACA recipients have been ineligible for Marketplace coverage since August 25, 2025, under a federal rule finalized in June 2025.

The IRS published proposed rules on these changes on October 15, 2026; comments are due November 30, 2026, so details may change. HealthCare.gov already states that, starting January 1, 2027, only green card holders, Cuban and Haitian entrants and COFA migrants among lawfully present immigrants can get help paying for Marketplace plans. If you are affected, compare employer, state and private options early in open enrollment.

Can immigrants get Medicaid or CHIP?

Medicaid and the Children's Health Insurance Program (CHIP) are joint federal-state programs for people with low income. Many green card holders must wait five years before qualifying. Starting October 1, 2026, federal Medicaid and CHIP eligibility for immigrants is generally limited to lawful permanent residents, Cuban and Haitian entrants, and COFA migrants. Refugees and asylees without green cards and several other lawfully present groups lost federal eligibility on that date.

• States may still use an option to cover lawfully residing children and pregnant people without the five-year wait.
• Some states fund coverage with their own money, though several have reduced these programs.
• Emergency Medicaid still covers emergency treatment for people who meet income rules but not status rules.

States are applying these changes on their own schedules and may be sending notices to affected enrollees. Check with your state Medicaid agency, or the Medicaid.gov immigrant eligibility page, for how the rules apply to you.

Emergency and low-cost care

Hospitals with emergency departments that take Medicare must screen and stabilize anyone with an emergency medical condition, regardless of ability to pay or immigration status. Federally qualified community health centers offer primary care on a sliding fee scale based on income. Many hospitals also have financial assistance policies; ask for one before paying a large bill.

Enrollment windows

Marketplace open enrollment runs each fall for coverage starting the next year. Outside that window, you generally need a qualifying life event, such as moving to a new state, losing other coverage, getting married or gaining lawful status, to enroll through a special enrollment period, usually within 60 days of the event. Employer plans have their own windows, typically 30 days after hire. Medicaid and CHIP accept applications all year.

Can immigrant children enroll in public school?

In Plyler v. Doe (1982), the Supreme Court held that states cannot deny children a free public education based on immigration status. Public schools from kindergarten through 12th grade must enroll eligible children who live in the district.

F-1 students may attend public high school for no more than 12 months and must pay the full cost. Children in other statuses, including dependents on work visas, generally attend public schools as residents.

Vaccines

States require certain vaccinations for school attendance, typically including measles, mumps and rubella, polio, diphtheria, tetanus and pertussis, hepatitis B and varicella, with exemptions that vary by state. Bring your children's vaccination records, translated if possible. Missing vaccines are often available at low or no cost through local health departments and the federal Vaccines for Children program for eligible children. Green card applicants inside the U.S. must also show required vaccinations as part of a medical exam on Form I-693.

Using U.S. health insurance

U.S. plans have their own vocabulary. The premium is what you pay each month. The deductible is what you pay for care before the plan starts sharing costs. Copays and coinsurance are your share after that, up to an annual out-of-pocket maximum. Most plans use a network of doctors and hospitals; going out of network usually costs more.

• Choose a primary care doctor soon after enrolling, so you are not looking for one when you are sick.
• Use urgent care clinics for problems that need same-day attention but are not emergencies.
• Ask for interpreter services. Many providers must offer language help at no cost.
• Federal law protects many patients from surprise bills for emergency care and certain out-of-network services.

College and in-state tuition

Plyler v. Doe covers K-12 education only. Eligibility for in-state tuition and state financial aid at public colleges is set by each state, and federal student aid is generally limited to citizens and eligible noncitizens, such as green card holders, refugees and asylees. Students on F-1 visas pay international tuition. Check with the college's admissions and financial aid office and your state's higher education agency.

What to ask an attorney or benefits counselor

• Does my status still qualify for subsidies or Medicaid after the 2026-2027 changes?
• Could my family's use of health programs affect a future green card application?
• Which state programs cover my children if federal coverage is not available?

Want help applying this to your situation? Email us to be connected with a participating immigration attorney, or see free and low-cost legal help.